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. . . February February Inside this Issue 1 2 3 3 4 5 6 7 A Quick Guide for Diabetic Foot Checks Fluid Management A Quick Guide for Diabetic Foot Checks Foot checks are performed monthly for each diabetic patient. It is important to participate in these monthly foot checks to identify potential problems that may lead to discomfort and infection. The following tips are things you can do to help keep your feet healthy. TIPS FOR EVALUATING APPROPRIATE FOOTWEAR: Cover Your Cough Stopping the Spread of Viruses 1. Check for foreign objects, torn lining and proper cushioning Keep Your Potassium in Control Advance Directives What are Directives they? Advance 2. Avoid pointed and opentoed shoes, high heels, thongs and sandals Continued Phosphorus Game Making Lower Phosphorus Food and Drink Choices Be Kind to Your Heart Dealing with Depression Dealing with Depression Continued 3. Shoes should be made of breathable expandable material such as canvas, leather, suede 4. Footwear should be adjustable with laces, Velcro, or buckles 5. Properly fitted athletic or walking shoes are fine for daily wear if there is room to accommodate any deformities 6. high risk patients may require depth-inlay shoes or custom molded inserts ! DO’S AND DON’TS OF FOOTCARE AT HOME DO: ✓ Wash feet daily with warm soapy water ✓ Dry feet well, especially between the toes ✓ Inspect feet daily: tops, bottoms, and between toes ✓ Apply moisturizing lotion daily to tops, bottoms, and heels of the foot ✓ Trim nails straight across ✓ Wear shoes that fit and protect your feet ✓ Check inside shoes for hidden objects before putting them on ✓ Break in new shoes gradually ✓ Tell your doctor or dialysis staff if you have any foot problems (Continued next page…) DON’TS: ➢ DON’T Soak feet, it causes dryness ➢ DON’T Check water temperature with feet or hands, use elbow or ask a friend your kidneys are not working properly, dialysis can remove some of the fluid, but you will also need to drink or eat less fluid. Having “too much” fluid can cause problems, some of which are serious. It is very important for you to follow the fluid restrictions your health care team prescribes for you. ➢ DON’T Use lotion that contains alcohol or perfume, it can cause further dryness What happens if I have too much fluid? ➢ DON’T Put lotion between the toes, it may cause buildup of moisture Some problems you may experience from gaining too much fluid are: ➢ DON’T Trim toenails yourself if you have poor vision, ask for a podiatry referral • Swelling in your ankles and feet called edema • Weakened heart muscle, and eventually heart failure caused from too much fluid stretching the heart muscle (enlarging the heart) ➢ DON’T Use razor blades or over the counter corn callus removers, consult a foot doctor ➢ DON’T Wear sandals or go barefoot ➢ DON’T Wear stockings with tight tips or seams which rub ➢ DON’T Expose feet to space heaters, car heaters, hot water bottles, or heating pads ♥ Fluid Management Adapted from DCi, Empowering Patients For a person on dialysis, fluid is usually restricted or limited. One job of healthy kidneys is to remove excess fluid from the body. When • Shortness of breath caused from too much fluid around the lungs • High blood pressure • Sudden drop in blood pressure causing you to feel faint or dizzy • Chest pain • Cramping during dialysis • Headaches, nausea and overall “bad” feeling during and after your treatment How do I know if I have too much fluid? Any of the symptoms can indicate you have gained too much fluid. For a person on dialysis, fluid is measured by weight gain between dialysis treatments. The members of your health care team will monitor your weight gains each time you come for a treatment. Your “dry weight” is your weight without extra fluid. This is used as your target weight after fluid has been removed. In dialysis, weight is often measured in kilograms. Each kilogram equals 2.2 pounds. Limit your fluid intake to 4 cups per day. It is important not to gain more than 2 kg (4.4 lbs.) between each treatment. For every 4 cups (32 oz) of fluid you drink/eat, you will gain about 1 kg. How can I control my fluid intake? 1. Avoid salt and salty foods. Salt makes you thirsty and can cause your body to retain fluid. 2. Measure all fluid with a standard measuring cup. 3. Chew sugar free gum. 4. Take medications with applesauce instead of liquid. 5. Suck on sugar free hard candy, especially sour candy. 6. Prepare a spray bottle with water and lemon juice or cherry juice and use to lightly spray your mouth. (Continued next page) 7. If you have diabetes, control your blood sugar. High blood sugar will make you thirsty. 8. Rinse your mouth with cold mouthwash. Do NOT swallow. same amount that you just drank into the bottle. When that bottle is full, you have used your fluid allowance for the day.♥ 9. Use a smaller glass with meals. 10. Brush your teeth often some tips to help stop the spread of germs. • Cover your mouth and nose with a tissue when you cough or sneeze. • You may be asked to put on a surgical mask to protect others. • Wash with soap and water or clean with alcohol based hand cleaner.♥ 11. A frozen lemon slice or a couple of frozen grapes can take the edge off your thirst. 12. Keep a daily fluid intake diary. 13. Start each day with an empty liter sized bottle (~32 oz bottle or quart jar). Each time you drink, pour the Whether we like to believe it or not, we live in a world filled with germs, bacteria, viruses, and other creepy crawly things. It is hard to remember to protect you and others against germs you can not see, but we all know they exist. Here are Keep Your Potassium in Control Potassium helps your muscles work and your heart is a muscle. Too much potassium can be dangerous for patients on dialysis. If your potassium is too high it can cause your heart to stop! For safety and feeling good, keep your potassium levels at 3.5-5.5. We get potassium from the foods we eat. People who are not on dialysis do not have to worry about their potassium levels because their kidneys will get rid of any excess potassium the body does not need. People who are on dialysis must control the amount of potassium they consume each day so that excess does not cause life threatening problems. A low potassium diet is considered to be around 2500 mg potassium each day. This may sound like a lot, but consider that 1 medium banana has over 450 mg potassium and 1 medium potato has over 700 mg potassium!!! Cover Your Cough Many fruits and vegetables have a lot of potassium. Choose from the following list of lower potassium fruits and vegetables to ensure your potassium does not get too high. Remember, limit each serving to ½ cup serving sizes. Discuss with your dietitian about how many servings of fruits and vegetables you can have in one day. Lower Potassium Foods: apples, grapes, strawberries, tangerine, plum, canned peaches, canned pears, pineapple, apple juice, cranberry juice, carrots, green beans, peppers, corn, cucumbers, zucchini, and radishes. Advance Directives An Advance Directive is a document that allows you to have control over healthcare decisions when you are no longer able to make decisions or communicate your wishes regarding your healthcare. Simply put, it allows you to “direct” your care in “advance” of the need. There are 3 types of advance directives: 1. A Living Will states that if your doctors know you cannot recover, you want only comfort care provided. A Living Will cannot take effect until you can no longer make or communicate decisions for yourself. Some states do not recognize the living will. Check with your social worker to be sure your state recognizes a living will; otherwise your wishes will not be able to be carried out. 2. A Durable Power of Attorney for Healthcare, or in some states it is called a Surrogate or Proxy Directive, is a document that allows you to choose someone to make decisions on your behalf when you are no longer able to make those decisions. 3. A Combine Directive lets you name a healthcare representative and tells that person your treatment wishes. It is important to ask your social worker about the types of advance directives available, since legal documents may vary from state to state. may be necessary for a court to appoint someone as your legal guardian. Or, your family may have to go to court to stop a treatment that they think you wouldn’t have wanted. An advance directive assures that your family knows what your wishes are. It helps take any burden away from your family members if they were to have to make decisions about your healthcare. What if I change my mind? You can change an advance directive or cancel it any time. If you change it, you need to give new copies to anyone who may have had a copy of your old advance directive. What treatments can I include in my advance directive? You can choose to receive pain medicines for comfort even if you refuse other treatments. You can accept or refuse other treatments such as: CPR (cardiopulmonary resuscitation), tube feedings, mechanical or artificial respiration (ventilator or respirator), antibiotics to fight infection, dialysis, surgery, and blood transfusions. Do I need a lawyer to make up an advance directive for me? Can’t my family just decide my healthcare for me without an advance directive? It is important to talk with family and communicate your wishes regarding your healthcare. However, if you do not have an advance directive and your doctor and family does not agree on your care decisions, it No. Your dialysis social worker has advance directive forms. Depending on the type of advance directive, it may need to be witnessed or notarized. What is cardiopulmonary resuscitation (CPR)? CPR is a common emergency procedure that is done to attempt to restore someone’s heartbeat. It is done by giving mouth-to- mouth breathing and pressing at intervals on the chest. “Shocks” to the chest are also done, if needed. Do I need an advance directive if I do NOT want CPR? The dialysis staff will respond to any dangerous lowering of your blood pressure by taking usual, ordinary measures for treatment of low blood pressure. This would be treatment such as giving you intravenous fluids and placing you in a physical position to improve blood flow to your upper body. If this treatment does not work and your breathing stops or your heart stops beating, CPR and electric shock treatment can be done, after which you will be taken to the hospital. To plan ahead in case this happens to you, a staff member will ask you to decide if you would want CPR or electric shock. You will also sign a paper that indicates the choice you make. This paper will be part of your medical record, and the staff will be informed of your wishes. It is important to know that if you refuse these life-saving treatments, it can result in death. Before you make this decision, you will have a chance to ask questions and discuss this with anyone you may choose. ♥ Choose Foods & Beverages Lower in Phosphorus INSTEAD OF CHOOSE Mental Floss Tips, Tactics, and Humor By: Janice R. Lee, MSW, LCSW Select the text box and double click its border. If you want to change the color or borders on a text box, choose the Colors and Lines tab. To change the size, scale, or rotation, click the Size tab. To change the position of the text box on the page, click the Position Tab. If you have other text surrounding the text box, and want to change the way the text wraps around it, click the Wrapping tab. The rest of this is placeholder text. As with the rest of the newsletter, just select it and overwrite it with yo This is placeholder text. This is placeholder text. This is placeholder text. This is placeholder text. This is placeholder text. This is placeholder text. This is placeholder text This is placeholder text. . Your By-line You can replace the pictures in this template with your company's art. Select the picture you want to replace, point to Picture in the Insert menu, and click From File. Choose a new picture and then click Insert. Select the Link to File box if you don’t want to embed the art in the newsletter. This is a good idea Are you flossing? I’m not talking about teeth. I’m talking about MENTAL Floss and your mind! Picture in your mind a piece of string going in one ear and out the other; the string moving back and forth in a flossing motion. This is mental floss! You have just cleared some cobwebs making way for new thoughts, ideas and actions! I think there is a reason the first two letters in Mental are ME. I am challenging each one of you to live your life to YOUR fullest. The T stands for Team. We, at your facility, are here to support you in blowing out those cobwebs of thoughts that are keeping you trapped in thoughts that are keeping you from reaching your goals or being happy. We are also here to give you facts. This knowledge is to help you make good decisions. We would also like the opportunity to address any myths so your health decisions are not affected by untruths. The rest of 2013 will be an enlightening year of hearing your stories. We want to promote open conversations with our patients. We want you to know we are opening our ears to your struggles and successes. Since February is Valentine's month, let’s focus on bringing up different feelings whether they are Happiness, Resistance, Anger, Love, Grief, Loneliness, Hopelessness, or Shame. TIP: DON'T IGNORE talk it out TACTIC: A Valentine gesture can be a random act of kindness HUMOR: ASSIGNMENT – Watch a funny movie and tell us about it so we can post in our Mental Floss Column next month. If it makes you smile, it will likely make someone else smile too! Be Kind to Your Heart 2. Discomfort in other areas of the upper body, for instance, pain in the arm, back, neck, jaw, or stomach. 3. Shortness of breath Did you know that kidney disease can cause heart problems? Here’s how: Congestive Heart Failure can happen when there is too much fluid in the blood. The heart fails to pump well enough to circulate all that fluid. The result is that it becomes hard to breathe, you tire quickly, and you have swelling (especially in your feet and legs). Increase Heart Muscle Size (Hypertrophy): This is when the heart muscle is overworked and thickens. The extra workload is caused by too much fluid and anemia. In anemia, there are not enough red blood cells to carry oxygen, so the heart pumps faster and harder to try to circulate more oxygen. What can you do? ♥ Control your fluids. 4. Others: sweating, nausea, dizziness Depression is not just a rare day of sadness. Feeling hopeless and helpless for a few weeks is a clue that you might be depressed. Sleeping or eating more or less than usual or missing dialysis treatments can also be clues. Reduce other risk factors for heart disease. ✓ Stop Smoking ✓ Control Blood Pressure ✓ Exercise ✓ Control Your Blood Sugar . . . . . . . . . . . . . . . . . . . . . . . . ♥ Don’t skip treatments. When you skip treatments you miss important doses of EPO and iron needed to keep you from being anemic. ♥ Know the warning signs of a heart attack. Get help, if you have these signs: 1. chest pain or discomfort that lasts more than a few minutes, or that goes away and comes back The good news is that depression can sometimes be prevented, and can always be treated. Why is depression important to me? Depression can take the joy out of life. It can steal your energy and make you feel like there is no hope, or no reason to go on living. If you are depressed, getting dressed and out of the house can feel like climbing a mountain. Being depressed can also make your health worse. If you are depressed, it can be hard to believe that life can get better again but it can. Getting help for depression can give you your life back. ♥ Take blood pressure medicines as prescribed by your doctor. ♥ Exercise you happy work any more. It is sometimes called “the blues” or being “down in the dumps”. Depression is very common after some of life’s most cruel events, such as death, divorce, or learning you have kidney failure. Experts say one of every three dialysis patients experience depression. Dealing with Depression What is Depression? Depression is a state of mind where none of the things that used to make What can I do if I feel sad or afraid? When you learn that your kidneys no longer work, it is normal to feel angry, fearful, and sad. Your doctor or nurse can answer medical questions, and a social worker at your unit can help you during this hard time. As a dialysis patient, you have so much to learn and many changes to fit into your life. (Continued next pg) Write down your questions, so you can get them answered and reduce your worrying. You will have ups and downs as you adjust to kidney failure. This is normal. Problem How can I prevent it? What should I ask? I just want to pull the covers over my head and sleep all day. • • Ma ke pla ns for a day that you will loo k for war d to. After you get used to your new life and get answers to your questions, you should start to feel better. Even though your dialysis schedule and new eating plan may be hard to get used to, they should start to feel like a normal part of who you are and what you do each day. Is ther ea sup port gro up me etin gI cou ld go to? • Are ther e clas ses nea rby that I cou ld tak e? Try to kee p bus y • • Wh ere cou ld I vol unt eer to hel p so me one els e? • Sta rt exe rcisi ng, eve na little . Is ther ea beg inni ng exe rcis e gro up I can join ? • Mo ve aro und to upb eat mu sic that you real ly like. • • Sur rou nd you rsel f with sig hts, sou nds , and sm ells that giv e you hap pin ess I have no energy. I’m restless, and have the blahs. • Spe nd at lea st 10 min ute s eve ry day out sid e in the fres h air. Wal k if you can or sit. • Is ther e any one I can wal k out sid e with ? I feel like I got a bad deal in life. • • List wh at you are grat eful for. Loo k at you r list eac h day and add to it. Wh o are the peo ple wh o hav e bee n goo d to me ? • Wh o are the peo ple I hav e bee n goo d to? • Try to see the bea uty and goo dne ss in the wor ld aro und you . Writ e it do wn. • Hav e an attit ude of grat itud e. • Re ach out pas t you • I can’t go on like this. • • • • • • • • • • • • • • • • Ca n you rec om me nd a ther api st for me to talk to? • Talk to you r soci al wor ker or reli gio us cou nse lor. • • • • • • Are ther e me mor ies I trea sur e? • Re ach out to you r fam ily and frie nds for sup port . • Ca n you pre scri be an anti dep res san t that will be saf e for me to tak e? See k prof essi ona l hel p, Ask for What can I do if I am a depressed? refe Try the following tipsrral everyday for a to a helped many few weeks. They have people feel better. Ifcou they do not nse help you at all, or if you feel like you lor. want to die, tell your • doctor and or social worker. There are many Ask types of medicationyou that can help r you feel better. doc tor abo ut dep res sio